A long-term care nurse shared that her facility was accused of negligence in failing to use bed rails properly to prevent residents from falling out of bed.
The report was denied by the organization. As a result, the RN was asked to complete an assessment of the entire facility for bed rail use. The RN did the assessment and documented her results.
According to the RN, the administrator told her bed rails were not to be used to define the parameters of a resident bed, and that if the bed rails were being used to prevent a resident from falling, they should be removed.
A resident’s family member raised a concern about the removal of the bed rails from her sister’s bed. The administrator denied that the bed rails were removed intentionally by staff. The resident was found deceased on the floor the next day, and the RN was asked to change her documentation of her assessment. She refused.
Subsequently, the RN was confronted by the administrator who said she had failed to do the assessment (although the RN says she found her assessment in the facility shredder box). The RN was also accused of not updating patient care plans, but she stated she had, in fact, done this and had taken screen shots of her updates. The administrator had another RN change the documentation done initially by the RN in question.
Three days later, the RN was terminated. Her question is whether or not she should report the facility and those involved.
Consulting an Attorney
The first step for this RN should be to seek a consultation with a nurse attorney or attorney whose practice consists of representing nurses and other staff in long-term care.
A consultation is essential not only in fashioning a report about the facility, but also to protect the RN. The submitted question is not entirely clear, and the facility’s motivation for removing bed rails (if the RN’s account is accurate) is quite disturbing.
What seems apparent is that there was an attempt to make the RN cooperate with the administrator and the other nurse in concealing the initial mandate to remove bed rails and in the death of the resident due to the bed rail situation.
The attorney will most likely discuss the federal Nursing Home Reform Act with the RN. This act requires that nursing homes provide quality care, protect residents from all forms of abuse and neglect, and spell out residents’ rights. Any nursing home receiving Medicare or Medicaid funds must comply with these standards.
In addition, the attorney will also review the state’s nursing home care act with the RN. This act and its official name may vary from state to state, but like the federal law, it lists residents’ rights and protects them from abuse and neglect.
Each act contains provisions for the enforcement of the act’s requirements when a violation occurs and where the violation is to be reported. For a list of each state law, click here.
Protecting the Nurse
The attorney will also focus on the RN’s conduct in order to protect her legally. The RN has evidence of her following the mandates of the administrator in assessing the bed rail situation and the documentation in patient care plans.
This evidence can be used in any legal forum, including a case filed by the deceased resident’s family against the nursing home or in a professional disciplinary hearing by the state board of nursing, if the nursing home files a complaint against the long-term care nurse for somehow contributing to the resident’s death.
The RN’s refusal to change her initial documentation and the fact that another RN changed her documentation (supported by the RN’s discovery of her copy in the facility shred box and her screen shots of the care plan updates she made) bodes well for her in any legal proceeding.
It appears that the RN has substantial, credible information about the conduct of the nursing home administrator and the nurse who changed her initial documentation.
Under the RN’s state nurse practice act and rules, the attorney will inform the RN that she has a duty to report the administrator to the board of nursing or other board that regulates nurse administrators and to report her RN colleague to the state board of nursing.
It is unfortunate that the long-term care nurse was terminated from her position at the facility. This is an outcome that often occurs when a nurse attempts to adhere to applicable ethical and legal standards of nursing practice.
If you find yourself in a similar situation, remember that you are accountable and responsible for your actions. Despite an end result of losing one’s job, be reassured that refusing to participate in any mendacious conduct is a reward that will continue to follow you in your future practice.
Take these courses to learn more about protecting patients and yourself:
Protect Yourself: Know Your Nurse Practice Act
(1 contact hr)
Nurses have an obligation to keep abreast of current issues related to the regulation of the practice of nursing not only in their respective states but also across the nation. Nurses have a duty to patients to practice in a safe, competent, and responsible manner. This requires nurse licensees to practice in conformity with their state statutes and regulations. This course outlines information about nurse practice acts and how they affect nursing practice.
Fall Prevention for Older Adults
(1 contact hr)
Falls are a serious health risk for older people, and a fall is a life-changing event that can lead to disability, loss of independence, or even death. About 28.7% of adults aged 65 and older fall every year. Healthcare professionals of various disciplines need to understand what causes seniors to fall and what the evidence shows can prevent the events. This course explains reasons older adults fall and strategies to keep them safe.
Document It Right: A Nurse’s Guide to Charting
(5.2 contact hrs)
Although documentation has always been an important part of nursing practice, the increasingly complex healthcare environment, litigious society and the diversity of settings in which patients receive care require that nurses pay more attention to documentation. The computerized patient record has become standard practice, and the days of repetitive task-oriented narrative notes are becoming part of nursing history.